Health, Department of

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Agency Web Site: https://www.health.ny.gov/

Mission

The mission of the Department of Health (DOH) is to ensure high quality health services are available to all New Yorkers. The Department is also the principal State agency that administers the Medicaid Program, the New York State of Health (NYSOH) Exchange, and other public health and health insurance programs.

The Department operates health care facilities including Helen Hayes Hospital, four veteran’s nursing homes, and the Wadsworth Centers for Laboratories and Research. In addition, DOH conducts oversight of health professionals and all other health care facilities to ensure that high quality, cost effective, health care alternatives are provided throughout the State.

Organization and Staffing

DOH is headed by a Commissioner, who is appointed by the Governor subject to Senate confirmation. The agency is organized into four major business units: the Office of Public Health; the Office of Primary Care and Health Systems Management; Institutional Management; the New York State of Health; and the Office of Health Insurance Programs which operates the Medicaid Program. Each of these business units contains multiple divisions and bureaus that work together to carry out DOH’s mission.

The workforce is spread out across the state, encompassing employees of the central office in Albany, four regional offices (located in Syracuse, New York City, Long Island, and Buffalo), the Wadsworth Center Public Health Laboratories, Helen Hayes Hospital (located in Haverstraw) as well as employees of the New York State Veterans’ Homes (located in Oxford, Queens, Batavia, and Montrose).

Budget Highlights

The FY 2023 Executive Budget recommends $204.3 billion for DOH, including $188.4 billion for Medicaid (representing the two-year appropriation authority), $6.5 billion for the Essential Plan, and $9.4 billion for remaining health program spending.

The Budget recommends a workforce of 5,980 full time equivalent employees (FTEs) for the Department. This is an increase of 560 FTEs from the FY 2022 Budget. The increase of 560 FTEs is associated with a phase-in of employees to support the State’s takeover of local district administration of the Medicaid program (300), with additional increases due to resources to conduct additional health facility surveillance operations (87), base adjustments from legislative impacts (79), Drinking Water State Revolving Fund (DWSRF) Federal resources (22), Medicaid Redesign Team (MRT) forecasted needs (22), rebuilding of essential public health management (10), creation of the office of workforce innovation (10), managed long term service and support increases (8), maternal health actions (8), health care bonus needs (6), the creation of the office of Medicaid innovation (4), investments in children’s behavioral health (2) and the promotion of primary care (2).

Major budget initiatives include:

• Medicaid Global Cap Metric Modification. As part of the MRT I, the FY 2012 Enacted Budget implemented the Medicaid Global Cap, which utilized the ten-year rolling average of the Medical component of the Consumer Price Index (CPI) to set the annual spending limit. The Budget proposes to update the metric used to set the Global Cap spending limit. The metric proposed is based on the five-year rolling average of Medicaid spending projections within the National Health Expenditure Accounts produced by Office of the Actuary in the Centers for Medicare & Medicaid Services. This new metric more accurately reflects spending growth of the entitlement program, including enrollment and high-cost populations. Additionally, the shorter timeframe is more reflective of recent trends and allows for more modest growth as compared to the ten-year rolling average of CMS Actuary projections. This action will provide the Global Cap $366 million in additional resources in FY 2023, and $899 million of additional resources in FY 2024.
• Across-the-Board (ATB) Rate Restoration and 1 Percent Rate Increase. In order to provide flexible funding for providers to respond to market needs and compete in the labor market to attract qualified workers, and to respond to industry requests for payment reform to be operationalized via a structural long-term increase to Medicaid inpatient and outpatient rates, the State is making a multi-year investment of $3.7 billion through restoration of the 1.5 percent reduction taken in the FY 2021 Budget, and increasing Medicaid rates across the board by an additional 1 percent.
• Workforce Investments. The Budget invests in multiple initiatives to support and retain the health care workforce that has worked tirelessly through the pandemic and to grow the workforce as the demand for health care services increases. Investments in the healthcare workforce include:
  • Healthcare Worker Retention Bonuses. The Budget invests $3 billion to support healthcare worker retention bonuses, with up to $3,000 bonuses going to full-time workers earning less than $100,000 annually who remain in their positions for one year and pro-rated bonuses for those working fewer hours.
  • Create an Office of Healthcare Workforce Innovation. The Budget invests $20 million to better coordinate statewide health and direct care workforce strategies, by creating an Office of Healthcare Workforce Innovation. This new Office will work across agencies and gather regular, organized input from health and direct care providers, educational organizations, labor unions, and other stakeholders to increase the supply of health care and direct support personnel and meet the demands in New York.
  • Nurses Across New York. The Budget invests $2.5 million in FY 2023 and $3 million annually starting in FY 2024 to establish and support a Nurses Across New York (NANY) program that mirrors the Doctors Across New York (DANY) programs to promote, strengthen, and increase the number of nurses in underserved communities across the State.
  • Doctors Across New York (DANY) Program. The proposal increases funding for the DANY program by $6.8 million in FY 2023 and $5.6 million annually starting in FY 2024 to provide loan forgiveness up to $120,000 for doctors who work in underserved areas over three years.
  • Diversity in Medicine Program. The State will invest $1 million in FY 2023 and $2.4 million annually starting in FY 2024 to enable the program to recruit and train a diverse healthcare workforce that represents the diversity of the patients in underserved communities to ensure health equity across the continuum of care.
  • SUNY Pre-Medical Opportunity Program. The State will invest $1 million annually to address persistent racial and income disparities in medical education by attempting to level the playing field for talented and capable Educational Opportunity Program (EOP) students who pursue a career in medicine.
  • Medication Technicians. Allowing specially trained Certified Nursing Assistants (CNAs) to dispense medications to residents in long term care facilities.
  • Interstate Medical Licensure Compact. The State will join the Interstate Medical and Nurse Licensure Compact enabling doctors and nurses to relocate to New York and use their existing license to more quickly practice in the State.
• State Takeover of Local Medicaid Costs. The Budget continues the Governor’s commitment to relieve local governments of Medicaid expenditure growth. In FY 2023, the State will assume nearly $5.2 billion in costs that would have otherwise been incurred by localities.
• Hospital Actions. The Budget invests $100 million to aid Financially Distressed Hospitals (FDHs) and structurally improve their financial position in the wake of the COVID-19 pandemic, as well as $250 million towards distressed provider costs, supported by the Distressed Provider Assistance Account which is funded by the counties and NYC. Other hospital actions include:
  • Delaying the Hospital Inpatient Rebasing and Reweighing from July 1, 2022 to any time on or after January 1, 2024, avoiding large financial swings in hospital rate impacts that would negatively impact hospitals and will have a net zero impact on State Operating Funds.
  • Investing $10 million in a technological efficiencies initiative to allow DOH to procure technical consulting advisors to assist Financially Distressed Hospitals (FDHs) in transformation plans to become financially sustainable healthcare providers.
• Promote Primary Care Actions. Investing $6.6 million net State share ($13.6 gross) when annualized to increase Medicaid reimbursements to physicians to expand services to more Medicaid enrollees and mitigate primary care shortages in limited primary care availability areas in the State.
• Nursing Home Actions. The Budget provides support to nursing homes by excluding provider taxes and capital from the definition of revenue in the 40/70/5 minimum spending statute to reduce the cost to nursing homes to implement the regulations, increasing funding by an additional $61.5 million State share to assist nursing homes with compliance with staffing regulations, and investing $100 million State share in financially distressed facilities.
• Managed Care The Budget fully restores $77 million in the Mainstream and Managed Long Term Care quality pools in order to incentivize and reward quality care. Additionally, the State will invest $34.7 million in the Medicaid Managed Long Term Care (MLTC) program and HIV Special Needs Plans by increasing plan premiums for certain plans to the middle and high end of the rate range.
• COVID-19 Testing. The State will provide continued support for COVID diagnostic efforts. Since the beginning of the COVID-19 pandemic, the State has successfully increased statewide capacity from 307 tests per day at the beginning of the pandemic, to over 400,000 tests per day – among the most in the nation – by leveraging the State’s healthcare system and infrastructure, utilizing partnerships with facilities and laboratories, and identifying new technologies to increase volume and rapid testing options. As new ways of testing have emerged, including rapid and over-the-counter at-home tests, New York State procurement and distribution efforts have provided millions of free test kits to local health departments, schools, and healthcare providers statewide. This includes the distribution of more than 10 million at-home tests to keep schools open and assist county health departments in responding to the winter COVID-19 surge. Current testing plans estimate the distribution of up to 37 million at home rapid tests statewide to continue to respond to emergent COVID-19 outbreaks.
• COVID-19 Vaccination Program. The State will provide continued support for the Statewide COVID-19 vaccination effort, which currently includes 14 State-run mass vaccination sites and a number of pop-up vaccination campaigns intended to target at risk and underserved populations. Beginning in December 2020 and continuing during 2021, New York State has implemented and rapidly scaled up statewide distribution of the COVID-19 vaccine. To-date, 35.2 million total doses of the COVID-19 vaccine have been administered in New York State, with 95 percent of adult New Yorkers and 83.4 percent of all New Yorkers having received at least one dose.
• Statewide Healthcare Transformation. The FY 2023 Budget continues $3.8 billion in capital investments for health care providers to transition into fiscally sustainable systems and to support capital projects, working capital and other non-capital projects. The Executive Budget also establishes a new $1.6 billion capital financing program for the purpose of funding capital improvements for eligible health care providers, investing in health care delivery transformation, financing information technology and telehealth improvements, and implementing innovative nursing home models. This will bring the total capital investments for health care providers to a historic $5.4 billion in total support through FY 2028.
• Drinking Water Federal Investment. The FY 2023 Budget includes $300.0 million in Federal drinking water appropriation authority to provide additional resources made available under the Infrastructure Investment and Jobs Act. These new dollars will provide a significant opportunity to improve public water systems, specifically those in communities disproportionately impacted by lead in drinking water, including debt retirement and no-interest loans for public water system projects, lead line replacements, and activities to address emerging contaminants.
• Roswell Park Cancer Institute (RPCI) Enhanced Lung Cancer Screening Program. The FY 2023 Budget provides a one-time investment of $4.0 million to RPCI for the procurement of lung cancer screening mobile vans and associated medical technology. These mobile vans will be deployed racially diverse neighborhoods and communities for early detection of lung cancer. In addition, the FY 2023 Budget invests $4.0 million in additional on-going operational support for Roswell Park to expanding and enhance cancer screening operations amongst diverse and underrepresented populations.
• RPCI Rashaun King Community Health and Education Center. The FY 2023 Budget increases the capital support for the RPCI by $2.0 million to provide support for the construction of the Rashaun King Community Health and Education Center. Current development plans are centered on the purchase of a residential home near the RPCI campus, which will then be renovated and expanded to meet the needs of the proposed community center.
• Increased Support for Newborn Screening. The FY 2023 Budget provides an additional $2.0 million in capital funding under the Wadsworth Center for Laboratories and Research. These resources will be used to procure additional laboratory equipment necessary to increase newborn screening testing capabilities.
• Wastewater Surveillance. The FY 2023 Budget invests $5.0 million of Clean Water Infrastructure Act funding for each year from FY 2023 to FY 2025, to support and expand the statewide wastewater surveillance Initiative, which conducts analysis of municipal wastewater for genetic markers of the COVID virus. The wastewater surveillance network will help guide policymaking for the COVID response, and the new expanded testing network will also be useful for monitoring the opioid epidemic and any future infectious disease threats that may arise.
• Investing in Healthcare Transformation. The Financial Plan reserves $1 billion of additional resources to further support multi-year investments in healthcare transformation and sustainability efforts.
• Support Harm Reduction and Naloxone Distributions. The Budget proposes to support additional Harm Reduction Services ($9 million recurring) and Naloxone distribution ($8 million in FY 2023 and $10 million thereafter) under the AIDS Institute by utilizing additional resources from the Opioid Stewardship Fund and the Opioid Settlement Fund, respectively.
• County Public Health Funding. The FY 2023 Budget recommends:
  • Investing $6.7 million in FY 2023 ($13.4M in FY 2024) for all counties and New York City to increase all General Public Health Work (Article 6) county base grants.
  • Investing $19 million in FY 2023 ($38M in FY 2024) to allow LHDs to claim for fringe benefits expenses to assist in the hiring and retention of staff.
  • Investing $5 million to implement a county-wide emergency medical services (EMS) overlay pilot in select New York counties.
  • A $65 million investment to support counties in building the infrastructure necessary for quick and reliable distribution of COVID-19 booster shots.
  • A separate $65 million investment to assist with the costs associated with administering COVID-19 vaccines and boosters, as well as enforcing the mask-or-vaccine mandate for indoor public places.
• Nourish NY. The Budget recognizes legislation to make the the Nourish NY Initiative permanent. The program will continue supporting New York's regional food banks and local food providers’ ability to purchase surplus locally produced food and goods from New York farmers and dairy manufacturers and deliver it to New York families in need. To date, New York has provided $97 million for the Nourish NY program, in addition to annual funding of $36.9 million through the Hunger Prevention and Nutrition Assistance Program (HPNAP) administered by DOH. New investments of $50 million included in the Budget will bring the total funding commitment for the Nourish NY program to $147 million.
• LGBTQIA+ Health Services. The Budget invests $7.0 million (in addition to existing $4.967 million funding) to support the LGBTQIA+ community with direct health services, cultural competency education and training, and organizational capacity building.

For more information on this agency's budget recommendations located in the Executive Budget Briefing Book, click on the following link:

Briefing Book – Health Care (PDF)

Program Highlights

Child Health Plus (CHP)

CHP provides comprehensive health coverage for children up to age 19 with family incomes above Medicaid eligibility levels. Like Medicaid, CHP is administered by states with guidance from the Centers for Medicare and Medicaid Services (CMS) and is jointly funded by the Federal government and states. Currently, nearly 400,000 New York children receive health coverage through CHP. Families with incomes below 160 percent of the Federal Poverty Level (FPL) receive free coverage for their children while families with incomes over that threshold pay on a sliding scale from about $9-$60/month per child. Enrollees in CHP receive primary, preventive, specialty and inpatient care.

Federal funding for the Children's Health Insurance Program (CHIP) has been reauthorized through FFY 2027.

The Executive Budget makes significant investments through the CHP program through:

• Eliminate Premiums for Low-Income CHP Families to ensure continuity of coverage for nearly 50,000 children.

• Expand benefits under CHP to align with Medicaid. These services include: Children and Family Treatment and Support Services (CFTSS); Children’s Home and Community Based Services (HCBS); Assertive Community Treatment (ACT); and Residential Rehabilitation for Youth (RRSY).

Elderly Pharmaceutical Insurance Coverage (EPIC)

The EPIC program provides drug coverage to income-eligible seniors aged 65 and older to supplement out-of-pocket Medicare Part D costs. This program serves approximately 327,0007 seniors annually and is financed entirely with State funds, which are offset by revenues from fees paid by EPIC members and rebates from drug manufacturers for generic drugs.

The Affordable Care Act (ACA) provides a phase-out of the Medicare Part D coverage gap (ended January 2020). The closure of the coverage gap will result in Medicare Part D picking up a larger share of program costs that were previously covered in EPIC.

Essential Plan (EP)

The EP provides health coverage for individuals with family incomes between 138 and 200 percent of the Federal Poverty Level (FPL) and for individuals from 0-200 percent FPL who are lawfully present in the United States but do not qualify for Medicaid due to their immigration status. The program has been extraordinarily successful, with nearly 800,000 New Yorkers enrolling at the end of FY 2020.The State receives Federal funding through the Essential Plan Trust Fund equal to 95 percent of what would have been provided to EP-eligible enrollees had they enrolled in the second lowest cost Silver Plan through the NYSOH. The EP offers a comprehensive package of benefits which include primary, preventive, specialty and inpatient care.

The Executive Budget makes significant investments through the Essential Plan through:

• Submitting a waiver to the Federal Centers for Medicare and Medicaid Services (CMS) that would allow the State to expand affordable coverage through the EP Program by raising the Federal Poverty Limit cap from 200 percent to at least 250 percent.

• Expanding the Essential Plan to provide coverage for long term services and supports.

• Expanding the Essential Plan to allow individuals to receive coverage for one-year post-partum regardless of any change to income.

Medicaid

Medicaid is a means-tested program that finances health care services for over 7 million low-income individuals and long-term care services for the elderly and disabled, primarily through payments to over 80,000 health care providers and more than 45 fully and partially capitated managed care plans. The Medicaid program is financed jointly by the State, the Federal government, and local governments. Eligible services include inpatient hospital care, outpatient hospital services, clinics, nursing homes, managed care, prescription drugs, home care and services provided in a variety of community-based settings (including mental health, substance abuse treatment, developmental disabilities services, school-based services and foster care services).

New York State of Health (NYSOH)

In 2013, in accordance with the Federal Affordable Care Act, the Governor issued Executive Order #42 to establish a New York Health Benefit Exchange. The Exchange – NY State of Health – serves as a centralized marketplace to shop for, compare, and enroll in a health plan. The health plans offered through NY State of Health are, on average, 55 percent less expensive than those available in 2013, prior to the creation of the marketplace. Since its inception in 2014, the NY State of Health has enrolled more than 6.3 million New Yorkers in affordable health coverage. The number of uninsured New Yorkers has declined by 1.3 million since 2010. The Budget includes $523 million in total funding in FY 2023 for the operation of NYSOH.

Public Health

DOH promotes and protects the health of people and the communities where they live, learn, work, and play. These efforts work to prevent people from getting sick or injured and promote wellness. DOH staff are responsible for a wide range of public health issues including tracking disease outbreaks, educating the public about the health risks caused by alcohol and tobacco, and developing school nutrition programs. Major programs include:

General Public Health Work (GPHW). The GPHW program, authorized under Article 6 of Public Health Law, provides reimbursement to counties and New York City for six mandated core public health services (Family Health, Communicable Disease Control, Chronic Disease Prevention, Community Health Assessment, Emergency Preparedness, and Environmental Health) by providing base grants and covering 36 percent of the remaining net costs, except for New York City, which is 20 percent.

• Early Intervention (EI). The EI program provides a comprehensive array of therapeutic and support services to children under the age of three with confirmed disabilities (e.g., autism, cerebral palsy) or developmental delays. The program serves approximately 71,000 children annually and is jointly financed by Federal, State and local governments.

Note: Most recent estimates as of 05/11/2020